For doctors online, common sense needs to be learned

Though I’ve personally been writing online for coming up on eleven years—basically the span of my entire medical career—I’ve never purported to be a pundit or expert when it comes to the topic of social media in medicine.  In some ways actually, I feel like Willy Loman, who built his little house in the middle of a field and later found himself surrounded by skyscrapers.  But the Internet has changed tremendously over the past decade, with the greatest leaps evident in the ways we use it to interact with others.  And the fact of it is that the interface between medicine and social media has always been unclear, and whose boundaries are evolving still.

Let me say first that medicine, above all fields, is slow to adopt change.  Sure, medical technology is evolving rapidly, but the culture of medicine, the technological change within our own ranks, moves at a glacial speed compared with other industries.  See, for example, the excruciating pace with which we have moved to adopt electronic medical records.  No other field in which the essential importance of recorded orders or observations, and the critical nature of interpretation error would be so inextricably tied to the the ability (or, as I see every day, the utter inability) to legibly hand-write notes with paper and pen.  And don’t even get me started on dictation.  Or pagers.  I could go on, but at this moment I am chained to my dictaphone, hand-writing a patient note with quill on parchment while working the butter churn with my feet.  Fresh butter in an hour, guys!

But the fact that medicine is slow to change does not mean that the rest of the world will follow suit, and the learning curve has been steep when it comes to the world’s oldest profession (no, not prostitution) dealing with the world’s newest media.

In many ways, medicine is like the military.  It is a combination of a hugely public and yet extremely private field, and both are intensely scrutinized and regulated.  So it is not surprising that medicine has been slow to adopt (or to even acknowledge) the Internet.  Sure, the medical world has long viewed the Internet as an incredible repository for information—even the most steadfast of medical Luddites will use PubMed and be the better for it—but when it comes to social media in medicine, at best most doctors think: why bother? and at worst, the perception is that the professional risk of engaging in social media well exceeds whatever marginal benefit can derived from it.

Do doctors need to have a web presence in order to do their jobs?  No, of course not.  Having a blog does not help me take care of my patient with the ruptured abdominal aortic aneurysm.  Having a Twitter account does not help me intubate my patient with the critical airway.  In some ways, interaction over the Internet is utterly peripheral to my everyday life of taking care of patients and my family, and possibly a distraction from those essential tasks.  Medicine is about triage, and over the course of a busy day, with a lot of other pressing obligations, it’s easy to look at something as seemingly frivolous as social media and think: it’s not important.

But it is important.  Certainly it’s important to patients, who by overwhelming majority, and for better or worse, look to the internet as a source of medical advice before seeing any of us.  It’s important to hospitals and medical schools, who are finding out more and more how indispensable it is to have a strong web presence.  And I’m willing to bet that young doctors-in-training, most of who are in that key 18 to 34 year-old demographic, think that social media is very, very important.  Look at this infographic from Mashable about how we interact with Facebook and tell me what you think.  You can decry it, you can shake your head in rue, but you have to at least acknowledge that this is the direction in which society is moving.  And then either bury your head in the sand and wish it away; or, as our training in medicine has taught us to do, you can observe and adapt your treatment plan.

Some medical institutions around the country have taken the stance that they will not allow their trainees to partake in social media at all.  And forgive me for being blunt, but: that’s dumb.  First of all, most of our future doctors are already engaged in Facebook or Twitter—probably both.  Most of them read blogs, some of them may write them.  So you can either ignore that, and give a blanket edict banning social networking entirely—a move which I suspect is roughly as effective as telling people to stop breathing.  Or we could start talking about it.  We could start educating our medical students and residents about what is appropriate interaction with social media, and what could be construed as unprofessional.  Instead of closing our eyes and wishing it away, we could start to be proactive and do what we were trained to do.  Educate.  React.  Adapt.  Here’s a start.  So is this.  And this.

Let me just say right here that if there is ever anyone who was in the position to make mistakes with respect to social media in medicine, it’s me.  Having come of age writing a blog way before there were conversations about this topic (let alone newspaper articles, lectures, or studies) I just had one thing, and really it’s all that each of us are left with and the end of the day when the noise dies down and the dust settles.  That thing, quite simply, is common sense.  You can’t tell doctors to stay off social media entirely, and many would argue (myself for instance) that you shouldn’t.  Because social media has tremendous power for good.  Dissemination of quality information.  Access.  Building community. Breaking down barriers between practitioner and patient.  Humanizing the practice of medicine, and humanizing the experience of those in our care.  But with the incredible power of social media comes great responsibility, particularly for those who see the human condition at its most vulnerable.  And we need to start teaching our young medical trainees, from an early age, about common sense when it comes to its use.

Because common sense is not obvious.  Sometimes it needs to be learned.  Now, as an attending, if I have a patient in the OR now who is desaturating, I instinctively go through a series of “common sense” steps to troubleshoot the problem.  At this point, it is ingrained.  But would it have been as obvious to me as a medical student, or even a resident?  Of course not.  I had to learn it.  Someone had to teach me.  It feels like common sense now, sure, but only through experience did it become instinct.

The world outside of medical school is changing, and it will continue to change over the next few decades in ways that we can’t imagine.  The Internet isn’t going away, and the way we interact with it as individuals is only going to get more fraught and more inescapable.  This is progression.  This is fact.  So  sure, we can hide or dismiss or disdainfully pretend we’re above it all.  Or, we can do what we do best, which is to roll up our sleeves, learn for ourselves how to deal with this brave new world, and then teach a new generation of doctors to do the same.

Michelle Au is an anesthesiologist and author of This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood. She blogs at This Won’t Hurt at Bit and the underwear drawer.  This article is reprinted with the author’s permission.

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  • http://twitter.com/BarryJOGorman Barry O’Gorman

    I think this is such a sensible and relevant analysis of the situation and the options facing doctors. Social Media are not going away. They represent another medium through which doctors can communicate with their patients, their prospective patients and the public at large. Blacket bans are pointless – in fact headed in the wrong direction.

  • buzzkillersmith

    Shorter posts are more likely to be read.

  • http://www.facebook.com/people/Arnold-Wax/100000381145770 Arnold Wax

    I disagree. You cannot learn or teach common sense. It is either inherent in one’s personal makeup or not. It’s tantamount to herding cats.